Patients with severe, nonchronic depression had better rates of recovery if they were treated with cognitive therapy (CT) combined with antidepressant medication (ADM) compared to ADMs alone.

here is a growing consensus that reducing depressive symptoms isn't enough and that a return to full normalization should be the goal. ADM is the most common treatment for depression, especially when the condition is more severe.

The authors conducted a randomized clinical trial with 452 adult outpatients with chronic or recurrent major depressive disorder (MDD) at three university medical centers in Philadelphia, Chicago and Nashville. The patients were treated either with ADM alone (n=225) or a combined treatment of CT and ADM (n=227). Treatments lasted for up to 42 months until recovery was achieved. Remission was defined as four consecutive weeks of minimal symptoms and recovery was defined as another 26 consecutive weeks without relapse.

A combined treatment of CT plus ADM improved rates of recovery compared to ADMs alone (72.6 percent vs. 62.5 percent) but the main effects of treatment on recovery were impacted by severity and the chronic nature of the condition. The advantage for combined treatment was limited to patients with severe, nonchronic depression (n=146) (81.3 percent vs. 51.7 percent). Recovery rates were similar among the two groups for patients with less severe MDD or chronic MDD. Patients who underwent combined treatment also reported fewer serious adverse events than patients treated with ADMs alone but this was largely due to less time spent in an MDD episode.

"Our findings suggest that CT engages different mechanisms than ADM but that it likely does so only in some patients. Identifying these mechanisms may suggest ways to enhance treatment response. Future combinatorial trials should include comparisons with CT alone to examine the viability of each monotherapy, especially given evidence that CT effects persist beyond the end of treatment."